Condition considerations

Any discussions regarding risk and benefit could include reference to the following areas:²

Blood clots

There is a small increased risk of blood clots, also known as venous thromboembolism (VTE), with oral – but not transdermal (patch, gel, spray) – HRT. Transdermal HRT should be offered to women at high risk for VTE, including those with a BMI over 30.

Cardiovascular disease

There is no increased risk of cardiovascular disease when HRT is started under the age of 60. There appears to be a small increased risk of stroke with oral HRT, but not with the transdermal formulation. However, the baseline risk in women under the age of 60 is very small. Studies have shown that starting HRT before the age of 60 – or within 10 years of the menopause – may reduce the risk of heart disease, but evidence so far is not strong enough to confirm this.

Diabetes

HRT does not affect the risk of developing diabetes and is unlikely to affect glucose.

Breast cancer

HRT does not affect the risk of dying from breast cancer. HRT with oestrogen alone is associated with a reduced risk of breast cancer.^2,3 HRT with oestrogen and progestogen can be associated with a small increased risk of breast cancer. This is related to duration of treatment and the risk reduces after stopping HRT. HRT may promote the growth of breast cancer cells in some women where cancer cells are already present, rather than causing cancer to develop.

It is unclear whether different types of progestogen are associated with different risks, however, there is some evidence that shows a lower risk with micronised progesterone.⁴ It should also be noted that being overweight and alcohol consumption (more than 14 units per week) are associated with greater risks than HRT. This is something that you can discuss during consultations to help women consider their current breast cancer risk and ways they can reduce it.

Dementia

The likelihood of HRT either reducing or increasing risk of dementia is unknown at present.

Sarcopenia

Muscle mass and strength decrease with age and can affect a person’s risk of falling and their standard of daily living. There is a possibility that HRT may have a beneficial effect in improving muscle strength and mass, but this is not certain.

Osteoporosis

While taken, HRT reduces the risk of osteoporotic fracture.